Abstract
Anemia is a common clinical problem in ICU. Almost universal by the end of first week after admission (1).How ever these result can be misleading because it is based on Hemoglobin concentration in blood as marker of Anemia. In ICU in critical illness it is a distinct entity although it is similar in many aspect to the anemia of chronic diseases, inflammation appears to be a measure factor. There are 3 major categories of anemia 1- Hypoproleferative anemia secondary to marrow production defects.2- In effective erythropoiesis caused by red cells maturation defects.3-Decreased servival of red blood cells. Secondary to blood loss, Hemolysis. Majority of anemia cases in ICU(75%) are hypoproliferative type. This article presents the current knowledge on defining various parameters of anemia in ICU, etiopathogenesis its relation to tissue oxygenation and overall highlights the common practice of transfusing red blood cells to correct anaemia which is an arbitrary intervension in critical care medicine
References
1. Vincent JL,Baron J-F,Reinhart K,et al.Anemia and blood transfusion in the critically.ill patients.JAMA 2002,288:1499-1507.
2. Jones JG,Holland BM,Wardop CAJ.Total circulating red cells versus hematocrit as a primary descriptor of oxygen transport by the blood.Br J Haematol,1990:76:228-232.
3. Cordts PR,LaMorte WW,Fisher JB,et al.Poor predictive value of hematocrit and hemodynamic parameters for erythrocyte deficits after extensive elective vascular operations. Surg Gynecol Obstet1992; 175:243-248.
4. Shander A.Anemia in the critically ill.Crit Care Clin 2004;20:159-178.
5. Stubbs JR.Alternatives to blood product transfusion in the critical ill:Erythropoetin, criti care med 2006;34;s160-s169.
6. Smaller BR, Kruskall MS.Phlebotomy for diagnostic laboratory tests in adults:pattern of use and effect on transfusion requirements .N Eng1 J Med 1986;314:1233-1235.
7. Corwin HL,Parsonnet KC,Gettinger A,et al.RBS transfusion in the ICU:is there a reason ? Chest 1995;108:767-771.
8. Wilkerson DK,Rosen AL,Gould SA,et al.Oxygen extraction ratio:a valid indicator of myocardial metabolism in anemia.J Surg Res 1987;42:629-634.
9. Levine E,Rosen A,Sehgal L, et al.Physiologic effects of acute anemia: implications for a reduced transfusion trigger.Transfusion 1990;30:11-14.
10. Weiskopf RB,Viele M,Feiner J,et al.Human cardiovascular and metabolic response to acute,serve,isovolemic anemia.JAMA 1998;279:217-221.
11. Hansen ES,Gellett S, Kirkegard L, et al. Tissue oxygen tension in random pattern skin flaps during normovolemic hemodilution. J Surg Res 1989;47:24-29.
Corresponding Author
Dr Arata Kumar Swain
Assistant Professor, Anaesthesiology, VIMSAR, Burla,
MD, Fellowship in Critical Care Medicine
DOI: http://dx.doi.org/10.18535/jmscr/v3i11.22
